Provider Demographics
NPI:1326048224
Name:LAINJO, GODDARD S (MD)
Entity Type:Individual
Prefix:
First Name:GODDARD
Middle Name:S
Last Name:LAINJO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 DOLSON AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-6489
Mailing Address - Country:US
Mailing Address - Phone:845-342-4655
Mailing Address - Fax:845-342-6850
Practice Address - Street 1:41 DOLSON AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-6489
Practice Address - Country:US
Practice Address - Phone:845-342-4655
Practice Address - Fax:845-342-6850
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
NY147716207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01038999Medicaid
NYWEX051Medicare ID - Type Unspecified
NYA99198Medicare UPIN